Ketoacidosis with Unexpected Serum Isopropyl Alcohol

A 34-year-old woman presented to the emergency department with a chief complaint of acutely worsening abdominal pain. The patient reported the abdominal pain to be in the left lower quadrant and of several months' duration but noted that it had worsened substantially over the previous 10 days. She also reported diffuse muscle pain and nausea without emesis, no food intake over the previous 72 h, and only limited recent fluid intake consisting of ginger ale, water, Gatorade, and homemade liquor. Her last menstrual period was 2 weeks before admission. Her medical history was remarkable for posttraumatic stress disorder, bipolar disorder, gestational diabetes, a previous gastric bypass surgery, and an ambiguous history of “injury to the liver and pancreas.” She denied taking any medications or other illicit drugs, specifically denied “binge” drinking, and had recently received a tattoo from an unlicensed tattoo artist. She was homeless and resided in a tent city with her husband.